Features

CUPERTINO, California — Apple is edging its way a little further into healthcare with the release of new iPhone apps that patients can use to manage their own medical conditions — from diabetes to pregnancy and even depression.

While there are hundreds of health-related apps on the market, Apple wants to put its stamp on a new ecosystem of treatment programmes. Rather than build the apps itself, the tech giant developed a set of software tools and templates, called "CareKit," that healthcare groups and health-tech startups can use to create their own programmes.

Apple says it wanted to help developers build easy-to-use apps for patients to record symptoms, get useful information, track their progress and even send reports to a doctor. Experts say the CareKit programme could help bring standards to a relatively new and unruly industry, while giving Apple a toehold in the growing health-tech market.

CareKit apps hitting the Apple online store this week include One Drop for diabetics; Start for people taking anti-depression drugs; and two apps from health startup Glow, aimed at women who are pregnant or caring for newborns. Apple says larger organisations, including the University of Rochester and hospitals at the Texas Medical Centre, are working on CareKit apps for people with Parkinson's disease and patients who've undergone heart or lung operations.

"These mobile tools can help people reach their health goals," said Thomas Goetz of Iodine, a startup that used CareKit in the latest version of its Start app. Along with providing information about side effects to depression medications, the app asks patients to record their symptoms and answer standardised questions to track how they're doing. Start uses a CareKit feature that lets patients send reports to their doctors; eventually, Goetz said, doctors will be able to respond by adjusting their instructions for medication, diet or exercise.

Data stored on iPhones is encrypted, and Iodine's app provides cautions to make sure patients understand they're sending sensitive information to their doctors. Goetz said his company is also developing back-end software for medical offices that will comply with federal confidentiality rules.

But Goetz acknowledged that doctors and insurers "are still trying to make sense of the world of healthcare apps. They're trying to understand which ones are valid tools and which aren't necessarily useful".

Apple's software could help validate new apps, he said, by letting developers build on a standardised template from a well-known company whose products are used by large numbers of people.

Apple says it isn't making money directly from CareKit, which grew from tools the company previously developed for researchers to create apps that collect iPhone users' data for health studies. But Apple could benefit if the apps gain wide adoption, making the iPhone an even more useful tool for millions of people with medical conditions.

"Even if you can't point to a revenue stream today, being the hub of an ecosystem related to healthcare could have great value in the future," said analyst Jeff Cribbs, who studies health technology for the Gartner research firm.

Apple CEO Tim Cook has signaled he believes the iPhone and Apple smartwatch can play a bigger role in healthcare. But the industry is heavily regulated and Apple has not ventured into making specialised devices that would be subject to federal oversight. Instead, the company leaves it to the developers who use Apple's software to determine if an individual app meets any health regulations.

BERLIN — Germany's auto industry risks being overtaken by foreign competitors unless it receives greater domestic support, the country's economy minister said Wednesday, announcing a 1 billion euro ($1.13 billion) plan to subsidise electric cars that are seen as the technology of the future.

Electric vehicles have had a sluggish start in Germany, the country where the combustion engine-powered automobile was born. A government plan to get one million e-cars on the streets by 2020 is far behind schedule, with just 50,000 sold so far.

"After a long debate we have agreed to a subsidy programme that aims to show on the home market that we can master these new drive trains, from plug-in hybrid to battery-powered vehicles, and make them suitable for the mass market," Economy Minister Sigmar Gabriel said at a news conference in Berlin.

Starting in May, buyers will get 4,000 euros ($4,514.80) towards the purchase of an all-electric vehicle, while plug-in hybrids will receive a subsidy of up to 3,000 euros. The cost will be shared equally by the government and industry.

Finance Minister Wolfgang Schaeuble said he would set aside 600 million euros for the rebates, which will be available on a first come, first serve basis. Another 100 million euros will be used to procure electric vehicles for the government's own fleet and 300 million euros will be invested in electric charging stations.

Gabriel said the goal was to increase the number of electric cars in Germany tenfold to 500,000 by 2020 — still only half the original target.

While foreign car manufacturers will be able to benefit from the subsidy, too, if they agree to contribute their share of the rebate, the only automakers that have signed up so far are Volkswagen, Daimler and BMW. Given German buyers' tendency to purchase domestic brands, the country's car industry is likely to benefit most from the program.

"This country will only have a chance to preserve its social, ecological, cultural standards if it remains a successful industrial nation," Gabriel said, noting the success of the programme to create a European aircraft manufacturer, Airbus, decades ago.

Japanese automaker Toyota has been commercially successful with its plug-in hybrids for years, while California-based Tesla is considered the cutting edge of all-electric vehicles.

"Now we're in a similar position," said Gabriel. "The reinvention of the automobile is currently being driven by companies that aren't based in Europe."

BOSTON – People who occasionally work night shifts may be at a slightly increased risk of heart disease, according to a new study.

Nurses in the study who worked at least three nights per month were more likely to develop heart problems over the next 24 years than nurses who stuck to daytime shifts.

"I think it’s an important message because it’s a potentially modifiable risk factor," said lead author Celine Vetter, of Harvard Medical School and Brigham and Women's Hospital in Boston.

For the new study, Vetter and her colleagues used data from more than 189,000 women. About 40 per cent were participating in the Nurses' Health Study (NHS), which began in 1988. The others were in NHS2, which began in 1989.

The women entered the studies between the ages of 25 and 55. At the start, none of them had coronary heart disease, which is when the arteries that carry blood to heart muscle become narrowed or blocked.

NHS participants were only asked once about their history of working night shifts, but NHS2 participants were asked about their night shifts every two years.

During the follow-up period, there were 7,303 cases of coronary heart disease problems — like heart attacks, chest pain and bypass surgeries — in the NHS study and 3,519 cases in the NHS2.

Overall, the risk went up with the number of years women spent covering night shifts, the researchers report in JAMA.

Compared to the risk for nurses in NHS2 who didn't work night shifts, the risk of coronary heart disease was 12 per cent higher in nurses who worked night shifts for less than five years, 19 per cent higher in those who worked night shifts for five to nine years, and 27 per cent higher in nurses who worked nights for at least 10 years.

But the risk of coronary heart disease came back down as women quit working night shifts or retired, the researchers found.

For example, women in NHS with at least 10 years of rotating night shifts had a 27 per cent increased risk of coronary heart disease during the first half of the follow-up period, but only a 10 per cent increased risk during the second half of the follow-up period.

The study can't explain the association, but Vetter said it could be related to increased inflammation in the body and social disruption. She also said the findings may apply to people who work early morning shifts since they have to get up during the night.

Once researchers have more data, Vetter said, they will be able to design healthy work schedules.

"Hopefully we can design schedules that are healthier for the individual," she said.

Once upon a time it was easy to get married. A boy and a girl above a certain age would decide to tie the knot and did exactly that, with a bit of frenzied partying thrown in, where copious amounts of food and drinks were consumed. In my home country India, courts had nothing to do with the nuptials of a couple whose marriage was performed according to the religious ceremonies followed by their community. In the presence of God, there was no reason for the magistrate to also preside over the proceedings. The entire process was so smooth that people could not stop doing it. Getting married, that is. Life was simple and uncomplicated. 

But the legal system did not recognise anything that was not put down in black and white on official paper with an authoritative stamp of approval by the officer in charge. If the law of the land required definitive documents to grant certain privileges, one had to basically provide them, we all know that. There was no getting around it. So, three decades after I took my matrimonial vows according to ancient Vedic rites, I was faced with the task of submitting a marriage certificate that I did not possess. My Portuguese lawyers thought I had left it in a safety deposit locker in India and gave me time to fetch it. They did not realise that there was nothing to fetch because I did not have any such documentation. 

Out of curiosity, I randomly asked the four Indian couples we were having dinner with that evening if they had got their marriage certified in a court. All four of them replied in the negative. It made me feel better but did not solve my problem. I needed to go to India and get married all over again, with two witnesses, one magistrate and the rest of it. My spouse had to go with me because this task could not be accomplished without his active participation. After talking to the Portuguese lawyers who were both shocked and scandalised that we were not legally wedded but still living together for so many years, I was not sure if I could even call my husband, well, husband. 

The tout we went to had an office in the back lanes of New Delhi. He produced a dossier of papers he had already arranged for us but the most significant one, called the “adhaar card”, was missing. This is the new unique identification card that every Indian must have, has been specified by our government in the last couple of years. Without this the online application would not even be accepted, we were informed. 

To initiate the process we trooped into a dilapidated building to get our fingerprinting done. That is where I discovered that I have something wrong with my fingertips. Even after 20 trials the machine could not register more than three of my ten digits on the screen. Soon, a small group of people gathered behind me with everyone giving out helpful suggestions. 

“Press the fingers evenly Madam,” one gentleman prompted. 

“I’m trying,” I said. 

“Error,” he read out. 

“Wipe your hands Ma’am,” a lady spoke up. 

“OK”, I wiped my fingertips vigorously on a tissue. 

“Error”, I heard them repeat. 

“Don’t move your fingers”, my spouse held my wrist. 

“Error”, announced the machine. 

“Iris scan successful” the clerk proclaimed. 

“That’s it? Are we married now?” I asked. 

“Not yet,” the crowd chorused. 

DUBAI — Already home to the world's biggest skyscraper, Dubai has another tall order to fill: By 2030, its leader wants 25 per cent of all trips on its roads to be done by driverless vehicles.

Monday's announcement by Sheikh Mohammed Bin Rashid Al Maktoum came without warning and with few details, as is sometimes the case with the many aspirations of the leadership of the United Arab Emirates (UAE).

In this car-crazed city-state of over 1.5 million registered vehicles, it's not unusual to see Ferraris idling alongside Lamborghinis at traffic lights. And Dubai already is home to a driverless Metro rail system, which carried 178 million riders in 2015.

Smart-car technology is being used in some of the world's luxury vehicles, and it is advancing rapidly enough for the plan to become a reality — or a nightmare for the thousands of taxi drivers who now plying the streets among the sleek skyscrapers in the UAE's commercial capital.

In a statement carried by the state-run WAM news agency, Sheikh Mohammed said the plan would cut down on costs and traffic accidents. The project would be a joint venture by Dubai's Roads and Transport Authority and the Dubai Future Foundation, he said, without offering how it would be funded in the oil-rich nation.

"Today, we lay down a clear strategy with specific goals for smart transportation to form one of the key drivers for achieving sustainable economy in the UAE," said Sheikh Mohammed, who can be seen driving himself around Dubai in his white Mercedes-Benz G-Class SUV, license plate No. 1.

Dubai boasts the world's tallest building with the 828-metre Burj Khalifa, which opened in 2010. In 2020, it will host the World Expo, a world's fair that is held every five years.

Mattar Al Tayer, the director general and chairman of the Roads and Transport Authority, said his agency has contacted a number of driverless vehicle sellers and "plans to conduct live test-runs for these vehicles in Dubai”.

His agency already has signed a deal with Toulouse, France-based driverless vehicle manufacturer EasyMile to conduct tests on their box-shaped EZ10, which carries up to 10 passengers, according to a statement from Tayer.

For now, Dubai and EasyMile haven't made any financial commitment to each other, said Ahmed Bahrozyan, the CEO of the Roads and Transport Authority's licensing agency. Instead, EasyMile is using the opportunity to test its battery life and air conditioners against Dubai's summertime heat, which goes easily beyond 40°C, he said.

"Our strategy is not only looking at private cars, but looking at taxis, looking at buses, looking at... cable car systems," Bahrozyan told The Associated Press.

BEIJING/DETROIT – Tomorrow’s cars will be all-electric, self-driving, connected to high-speed communications networks... and free.

And probably Chinese

That, at least, is the vision of Jia Yueting, a billionaire entrepreneur and one of a new breed of Chinese who see their technology expertise re-engineering the automobile industry, and usurping Tesla Motors, a US pioneer in premium electric vehicle (EV) making.

“Tesla’s a great company and has taken the global car industry to the EV era,” Jia said in an interview at the Beijing headquarters of his Le Holdings Co., or LeEco. “But we’re not just building a car. We consider the car a smart mobile device on four wheels, essentially no different to a cell phone or tablet.

“We hope to surpass Tesla and lead the industry leapfrogging to a new age,” said Jia, wearing a black T-shirt and jeans.

A wave of EV start-ups has emerged in China after the government opened up the auto industry to deep-pocketed technology firms to drive a switch to cleaner electric as an eventual alternative to gasoline cars. Sceptics wonder just how start-ups like LeEco will deliver on their grand visions.

As a sign of intent, 43-year-old Jia last week unveiled the LeSEE electric concept supercar, a rival to Tesla’s Model S. The “smart, connected and self-driving” car will be displayed at this week’s Beijing auto show.

“People questioned our idea, a small IT company building a car to compete with the BMWs and Teslas of the world, and laughed at us. It wasn’t easy, but here we are,” Jia told Reuters.

Made in nevada

LeEco hopes to start producing a version of the LeSEE in a few years at a plant being built near Las Vegas by US strategic partner Faraday Future, in which Jia has invested. Those cars would be sold in the United States and China. Further ahead, the plan is to produce electric cars in China, too, probably through a partnership with BAIC Motor.

The web-connected electric cars will have a “disruptive” pricing model similar to phones and TV sets LeEco markets in China, Jia says. His company, often called China’s Netflix, will sell movies, TV shows, music and other content and services to drivers of its cars. That’s why he says “one day our cars will be free”. Nearer-term, the disruption is more likely to be “double the performance at half the price”.

Beyond LeEco, Chinese tech heavyweights including Baidu, Alibaba, Tencent and Xiaomi have funded more than half-a-dozen EV start-ups, such as NextEV and CH-Auto. It’s widely expected China’s bus, taxi and courier firms will be encouraged to go electric.

“We define our car in a whole new way... instead of copying Apple and Tesla,” LeEco co-founder and vice chairman Hank Liu told Reuters. “Our products are not upgraded from those that already exist. They are revolutionary... products that never existed before.”

While the entry barrier has been lowered as electric cars are, mechanically, relatively simpler to produce, sceptics query how China’s start-ups will fund and make tens of thousands of industry-changing EVs — from design through to procuring the 10,000 or so parts and systems needed for the finished product.

Daimler said Hubertus Troska, head of its Greater China business, was invited to LeEco last month to get to know the company and its business model.

“I told Mr Troska we’re going to redefine the car,” Liu told Reuters. “EVs for us are just another screen. We see cars in the future as an extension of the Internet, another entry point for us to sell web-based content and services.”

Jia has also had to overcome questions on his funding. In the past three years, there was speculation he had disappeared and had his passport confiscated because of his ties to a brother of Ling Jihua, a high-ranking Communist Party official who was arrested last year and is under investigation for graft.

THE HAGUE – Would you like a drone with your cocktail? The world’s first cafe using the tiny domestic unmanned aircraft as servers has opened in a Dutch university.

The pop-up drone cafe will be serving up all weekend as part of celebrations for the “Dream and Dare” festival marking the 60th anniversary of the Eindhoven University of Technology.

The 20 students behind the project, who spent nine months developing and building the autonomous drone, aim to show how such small inside craft could become an essential part of modern daily life.

“It has potential as a useful tool for human kind. We see it as the next mobile phone. You choose and you programme it like you want,” student and project leader Tessie Hartjes told AFP.

The drone, nicknamed Blue Jay, which resembles a small white flying saucer with a luminescent strip for eyes, flies to a table and hovers as it takes a client’s order, who points to the list to signal what they would like.

“The blue eyes of the first drone load” up by scanning the list to register the order, said Hartjes.

“Once it’s fully loaded, then the order is ready. And another one comes with the order in a cup in the grip.”

The cafe is offering four different alcoholic and non-alcoholic cocktails, which are either bright blue or green — the same colour as the drone’s “eyes”.

The drinks are picked up and carried by a set of pinchers underneath the drone, in a bid to show that these aerial machines could be used to carry out delicate missions such as delivering medicines or even helping to track down burglars.

Each drone has cost about 2,000 euros to build, in a project funded by the university which the students say aims “to give a glimpse of the future”.

Thanks to sensors and a long battery life they can fly inside buildings and navigate crowded interiors, unlike other drones, which rely on a GPS system.

“The Blue Jay is an intelligent bird that lives in complex, social environments,” the students say in a video presenting their work.

They believe the drone’s applications could be endless: as extinguishers to put out fires, alarm systems to warn of intruders or mini-servants which would respond to commands such as “fetch me an apple”.

“We believe that one day, domestic drones will be a part of society. One day, a drone could be a friend,” says one of the students in the video presentation.

CAIRO –– Egyptian mother Aaz Menhom cups her hands under a running tap in her yard to let her young children Atef and Nada drink. 

"It's a blessing from God. I was bathing them once every four days, now they can wash every day," she says, beaming broadly.

Menhom, 27, whose family share a sparsely furnished one-room home with her sister and five nephews, used to have to ask for water at neighbours' doors.

Armed with a bucket, she had to repeat the exhausting process several times a day just so she could do her daily chores.

But all that has now changed as a result of clickfunding, a concept launched in Egypt by a startup business, Bassita, that has transformed Menhom's life for the better.

Bassita, which means "simple" in Arabic, is harnessing the growing Internet penetration in the country and raising funds through social networking campaigns.

It posts photos and videos of micro-development projects, and sponsors undertake the funding once a certain number of shares and "likes" are raised.

"You're one click away from changing the world," reads a banner on the bassita.org website, founded in 2014 by two Frenchmen in their 30s who have settled in Cairo, Alban Menonville and Salem Massalha.

The goal is to "revolutionise" online advertising, said Menonville.

"If I want Facebook advertising to reach a million people, Facebook will ask me a price," he said. 

"Instead of paying it to Facebook the idea is to pay it for something positive, and the Internet user will provide visibility," he said.

"The user becomes a philanthropist," said Massalha, who is of Egyptian origin. "As far as we know, no one else uses this model."

The company has also boasted success in other fields.

Partnered with a Cairo optician, it campaigned in 2014 to fund 1,000 pairs of spectacles for craftsmen and women, including embroiderers in the impoverished Fayoum province, southwest of Cairo.

 The dramatic improvement in Menhom's life came through a joint campaign with the United Nations Children's Emergency Fund (UNICEF) to supply running water to 1,000 homes in southern Egypt.

About 7.5 million people in Egypt have no access to clean water in their homes.

A video showing the comedian Maged Al Kedawny, along with the Arabic hashtag "a click connects to water", was viewed on Facebook more than 2 million times in three days after the campaign's launch in February.

One hundred homes have been connected to piped water since mid-March, according to UNICEF.

"In the next six months, 1,000 homes will be connected to water in four provinces," said its Egypt representative, Bruno Maes. 

Several companies are financing the $170,000 project, which includes a hygiene awareness programme.

Among the sponsors are US giant SC Johnson, Egypt's Wadi Degla and the Emirati ride hailing app Careem.

"In the end everyone is a winner, there will be more people who see the campaign, and the more money invested, the more partner companies gain visibility," said Careem's director in Egypt, Shalaby Hadeer.

Bassita, which won a 2015 Orange Prize for African social ventures, wants to export its success story.

"Europe needs environmental projects, Africa perhaps more in health and transportation. This model can apply to all those problems," said Menonville.

BEIJING –– In the race to develop self-driving cars, the US and Europe lead in technology, but China is coming up fast in the outside lane with a regulatory structure that could put it ahead in the popular adoption of autonomous cars on its highways and city streets.

A draft roadmap for having highway-ready, self-driving cars within 3-5 years and autonomous vehicles for urban driving by 2025 could be unveiled as early as this year, said Li Keqiang, an automotive engineering professor at Tsinghua University who chairs the committee drafting the plan. The panel is backed by the powerful ministry of industry and information technology.

The draft will set out technical standards, including a common language for cars to communicate with each other and infrastructure, and regulatory guidelines — a unified framework that contrasts with a patchwork of state laws and standards in the United States.

Without coordination, that patchwork could hold back the development of self-driving cars in the US, David Strickland, a former safety chief for the National Highway Traffic Safety Administration, said at an event in Beijing this month.

China’s top-down approach could see it overtake the US and Europe, where automakers have generally been left to agree among themselves on industry standards. A push for self-driving and electric cars also fits with Beijing’s shift to an economy driven by high-tech and consumer industries rather than heavy industry and low-end manufacturing.

“If we can convince the government that every company, every car on the road must use this [single standard]... then there is a chance China can beat the rest of the world” to the widespread use of self-driving cars, said Li Yusheng, head of Chongqing Changan Automobile’s autonomous drive programme.

China is ripe for the advent of self-driving cars. It’s the world’s biggest autos market and is blighted by choking air pollution, traffic congestion and often erratic driving. More than 200,000 people die each year in road accidents, according to World Health Organisation estimates.

As relative newcomers to mass car ownership Chinese also tend not to share the West’s love affair with driving. In a 2015 World Economic Forum survey, 75 per cent of Chinese said they would likely ride in a self-driving car, versus half of Americans. Within 20 years, China will be the largest market for autonomous features, accounting for at least a quarter of global demand, says Boston Consulting Group.

Big ambitions

The China draft would be opened up for industry comment and input from a range of ministries, ultimately going to the State Council, or Cabinet, for approval.

At a most basic level, the committee will define a “self-driving” car and set a minimum level of functionality, said Bai Jie, a professor at Tongji University who also sits on the expert committee.

In other respects, China plans to be more ambitious. It may adopt cellular data technology — already used in many cars to access the Internet — for cars to communicate, rather than the dedicated short-range communications (DSRC) standard used in the US and Europe, said Li, the panel chairman.

“The US, Europe and Japan spent so much time developing DSRC, so they strongly recommend it for China,” Li said. “Here, we’re just beginning so why not choose advanced technology like LTE (Long Term Evolution wireless broadband technology) or 5G?”

China’s provisional timeline would put it at least in line with, if not ahead, of others developing self-driving cars.

By 2020, Toyota Motor aims to market a car that can drive by itself on highways, and Mercedes, after two decades of research, plans to launch a self-driving car, though drivers would be required to take control in certain situations.

Chinese automakers including SAIC Motor and Ford Motor’s local partner Changan have internal targets that match the likely draft roadmap, and are represented on the experts committee, Li said, while foreign carmakers are not.

NEW YORK –– People taking common heartburn medications known as proton pump inhibitors (PPIs) are at increased risk of new and severe kidney disease, according to a US study.

Among hundreds of thousands of patients in Department of Veterans Affairs (VA) databases, new users of PPIs without kidney disease were 30 per cent more likely to develop chronic kidney disease over the course of five years. Their risk of kidney failure was doubled.

PPIs like Nexium and Prevacid are prescribed to treat ulcers, heartburn and acid reflux and are some of the most effective forms of treatment available, the study authors write in the Journal of the American Society of Nephrology.

These drugs are generally viewed as safe and may be overprescribed and continued for long periods without being necessary, they note.

“We suggest judicious use of PPI, and that use be limited to when it is medically necessary and to the shortest duration possible,” said senior author Dr. Ziyad Al Aly, associate chief of staff for research and education at the VA Saint Louis Health Care System.

The study team analyzed data in national VA databases on 20,270 people who had recently started taking PPIs. They compared this group to 173,321 people who had started taking H2 blockers, a group of drugs that reduce stomach acid by a different mechanism, blocking histamines in the stomach.

All patients were free of kidney problems at the start, and were followed for five years to see if their kidney function changed. 

After adjusting for personal, social and economic factors as well as health conditions that could influence kidney disease risk, the study team found that people taking PPIs were at significantly higher risk of new kidney problems compared to those taking H2 blockers.

The risk of a decline in kidney function was 32 per cent higher for people taking PPIs and the risk of new cases of chronic kidney disease was 28 per cent higher. 

Patients taking PPIs were 96 per cent more likely to experience end-stage renal disease — kidney failure — than those who took H2 blockers.

The risks also increased with the time that someone was taking PPIs, leveling off after about two years of use.

Because many PPIs are available over the counter, people may take them without the input of a doctor, Al-Aly said. He recommends limiting the use of over the counter PPIs to only times when it is necessary.

“If people find themselves taking over the counter PPI frequently, then a doctor consultation is definitely needed to determine best and safest options available to that patient,” Al Aly told Reuters Health by email.

H2 blockers are much less likely to cause kidney problems but often aren’t as effective as PPIs, said Dr. David Juurlink, a clinical pharmacologist and drug safety researcher at the University of Toronto, said by email.

“For many patients, dietary modification [less fat and alcohol] would make acid-lowering drugs unnecessary and would impart other long-term benefits as well,” said Juurlink, who was not involved in the study.

“Patients should appreciate that, like all drugs, PPIs carry risk. The fact that they’re available over the counter doesn’t mean they’re safe,” Juurlink said. 

“People who take PPIs and are later found to have kidney problems should ask their physicians whether the drugs might be playing a role,” he advised.